Emily Lucille Teesdale, A-GNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704274128 Issued in MI

Practice address

145 Michigan St NE Ste 3410
Grand Rapids, MI 49503-2563

Phone

(616) 391-9945

NPI assigned

Jul 11, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1982126009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 3410",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032563",
            "telephone_number": "616-391-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEESDALE",
        "first_name": "EMILY",
        "middle_name": "LUCILLE",
        "name_prefix": "Mrs.",
        "credential": "A-GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704274128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chase Teague
• Team Cook Inc
• Alyssa Teaster
• Suzanne M Tebeest, LMSW
• Maria Elizabeth Tecos, MD
• Shelly Germaine Teesdale, MSOTR/L
• Jenna Teeter, BS
• Kelly S Teft, PA-C
• Morad M Tehrani, MD
• Erin N Teitsma, PA-C

• Gerontology Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.